Key result
Among pregnant individuals with moderate to severe cardiac disease, Black race was associated with a significantly higher rate of cardiac severe maternal morbidity compared to White race (23.71% vs 5.41%, adjusted OR 3.80).
Why the study?
Cardiac disease is a leading cause of severe maternal morbidity, but the effects of race and rural-urban status on cardiac-specific severe maternal morbidity in North Carolina required estimation.
Do racial and rural-urban disparities affect the rate of cardiac severe maternal morbidity in pregnant individuals with preexisting cardiac disease?
Cohort (n=106,778)
Yes
Do racial and rural-urban disparities affect the rate of cardiac severe maternal morbidity in pregnant individuals with preexisting cardiac disease?
Black individuals with moderate to severe preexisting cardiac disease experience significantly higher rates of cardiac severe maternal morbidity during delivery hospitalizations compared to White individuals.
Disparities signal need for equity-focused peripartum strategies; extends disparity research but leaves open causal factors in cohort data.
Background Cardiac disease is a leading cause of severe maternal morbidity (SMM). We sought to estimate the effects of race and rural-urban status on cardiac-specific severe maternal morbidity (“cardiac SMM”) in North Carolina. Methods This retrospective study used the 2019 North Carolina State Inpatient Database (SID). Diagnosis codes were used to identify births, comorbidities, modified World Health Organization (mWHO) cardiac category, and outcomes. Hospital-level data were obtained from publicly available sources and the SID datasets. The primary outcome was a composite of cardiac SMM. Results Of 106,778 births, 369 had mWHO category I–II disease, and 366 had mWHO category II/III–IV disease. Individuals with cardiac disease had higher rates of cardiac SMM (10.4% versus 0.27% versus 0.13% for mWHO II/III–IV, mWHO I/II, and no disease, respectively). Among patients with mWHO II/III–IV disease, 60.0% of rural residents delivered at hospitals with advanced cardiac capabilities versus 80.8% of urban residents; there were no statistically significant differences in cardiac SMM rates (11.3% versus 10.1% for rural versus urban individuals, P = NS). In contrast, there were pronounced disparities in cardiac SMM among Black individuals compared with White individuals (0.28% versus 0.13%, P < .001), especially among individuals with mWHO II/III–IV disease (23.71% versus 5.41%, P < .001). Limitations Cardiac disease and outcomes were identified based on diagnosis and procedure codes. Identifying complications subsequent to the delivery hospitalization was not possible. Conclusions In North Carolina, there is a pronounced racial disparity in cardiac SMM during delivery hospitalizations, which is driven by patients with mWHO II/III–IV disease.
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Moyett et al. (2023) conducted a cohort in Maternal cardiac disease (n=106,778). Black race (among patients with mWHO II/III-IV disease) vs. White race was evaluated on Cardiac severe maternal morbidity (cardiac SMM) (OR 3.80, 95% CI 1.82-7.92, p=<0.001). Among pregnant individuals with moderate to severe cardiac disease, Black race was associated with a significantly higher rate of cardiac severe maternal morbidity compared to White race (23.71% vs 5.41%, adjusted OR 3.80).
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